Peter Kranz, M.D.
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petergkranz.bsky.social
Peter Kranz, M.D.
@petergkranz.bsky.social
Division Chief of Neuroradiology at Duke University Medical Center. Research in #spinalCSFleak #SIH. Tweets my own. No discussion of individual patient care. #radsky #neurorad
Reposted by Peter Kranz, M.D.
"Density and Time Characteristics of CSF-Venous Fistulas on CT Myelography in Patients with Spontaneous Intracranial Hypotension"

doi.org/10.3174/ajnr...

@The_ASSR @dgleao @TimAmrheinMD @PeterGKranz #CSFLeak
May 10, 2025 at 3:48 PM
Reposted by Peter Kranz, M.D.
"Safety and Technical Performance of Bilateral Decubitus CT Myelography Using Standard versus Increased Intrathecal Iodinated Contrast Volume"

doi.org/10.3174/ajnr...

@dgleao @PeterGKranz @The_ASSR #CSFLeak #EditorsChoice
March 11, 2025 at 7:16 PM
Reposted by Peter Kranz, M.D.
"While we found a statistically significant higher renal contrast excretion in patients with SIH compared with patients without SIH during early-phase CTM, no useful threshold value could be established that could reliably distinguish these groups with both high sensitivity and high specificity."
February 11, 2025 at 8:24 PM
Reposted by Peter Kranz, M.D.
"Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension"

doi.org/10.3174/ajnr...

February 11, 2025 at 8:24 PM
📄New paper on ICP monitoring in pts with orthostatic HA and negative imaging found that most common identifiable pressure issue was high pressure (!)

“3 patients had low ICP (8%) and 6 patients had high ICP (16%). The remaining [had neither] (76%).

🤔

pubmed.ncbi.nlm.nih.gov/39905291/
Intracranial pressure monitoring in patients with spontaneous onset of orthostatic headache - PubMed
Portions of this work were presented in abstract and oral presentation form at the Twenty-eighth Anglo-Dutch Migraine Association meeting (08/06/2018), the Tenth Meeting of the International Society f...
pubmed.ncbi.nlm.nih.gov
February 8, 2025 at 7:23 PM
So what exactly makes a headache orthostatic anyway?

📄 New paper alert 📄

journals.sagepub.com/doi/full/10....
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January 17, 2025 at 12:53 AM
Reposted by Peter Kranz, M.D.
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January 6, 2025 at 9:13 PM
Most EBPs in the community are performed without imaging guidance.

Case report of how an intact plica dorsalis mediana prevented bilateral spread of blood, necessitating a second EBP under imaging.

Consider when EBP for PDPH “fails.”

scholar.google.com/scholar_url?...
scholar.google.com
December 30, 2024 at 5:28 PM
📄 New Paper Alert! 📄

“Flow Void Sign”: Flow Artifact on T2-Weighted MRI Can Be an Indicator of Dural Defect Location in Ventral Type 1 Spinal CSF Leaks

Congrats to @neuroradlal.bsky.social, @dgleao.bsky.social , David Butteriss, @brainscandan.bsky.social - super useful - I'm a believer!!
“Flow Void Sign”: Flow Artifact on T2-Weighted MRI Can Be an Indicator of Dural Defect Location in Ventral Type 1 Spinal CSF Leaks
Patients with spontaneous intracranial hypotension caused by type 1 dural defects typically have an epidural fluid collection on MRI. Still, the location of the defect is not usually readily identifia...
www.ajnr.org
December 11, 2024 at 8:42 PM
Headache that worsens upon standing may prompt suspicion for CSF leak.

But there is a normal sharp spike in CSF pressure immediately upon standing.

In some patients with IIH or RIH, this can paradoxically cause HA upon standing, tho usually transient.

Fig: PMID 34715658
December 7, 2024 at 1:48 AM
Fascinating series of articles on CTD in Neurology in #FrontiersinNeurology including #CSFleak and orthostatic HA.

Great discussion and hypotheses- but surprising how little primary data underpins our current understanding. #knownunknowns

www.frontiersin.org/research-top...
Neurology and Connective Tissue
Connective tissue compromise, as is seen in the heritable connective tissue disorders collectively called Ehlers-Danlos Syndrome, but also acquired connective tissue disorders as can be seen in autoim...
www.frontiersin.org
November 30, 2024 at 6:11 PM
Don’t want to read that spine case? Come to THIS session at #RSNA2024!

Mon Dec 2, 8-9am, Rm S406B

> Is this spinal finding actionable?
> Is this spinal infection?
> What am I looking for on this CSF leak spine imaging?
> What am I looking for on this postop spine imaging?
November 29, 2024 at 10:19 PM